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The Tampa Tribune

Published: October 25, 2009

The debate about the health care system's overhaul is filled with topics and terms unfamiliar to many. Each week, we'll examine some of the issues, the politics behind them and how they would affect consumers.

WHO WILL GAIN, LOSE?

Which industries stand to gain or lose most from a health care overhaul?

THE POLITICS: The tally on winners and losers won't be in until a final bill emerges, which is why lobbying is intense. Any measure that creates millions of additional insured people will mean more paying customers for health insurers, hospitals, doctors and drugmakers. With the notable exception of insurers, many industries skeptical about the effort have tempered their criticism in hopes of retaining influence with lawmakers. The insurance lobby says it still supports a health overhaul, but recently issued two reports and a TV ad attacking provisions it says will drive up health care costs, prompting a Democratic backlash with uncertain results.

WHAT IT MEANS: Insurers object to the inclusion in any bill that emerges of optional government-run coverage, arguing that would reduce their market share. They also fear harm if a requirement that people buy insurance is not strongly enforced. Doctors, hospitals and drugmakers worry their reimbursement rates will be too low, and care providers oppose billions in fees the Senate Finance Committee bill would impose. Businesses large and small win if the steady growth of their health care costs is curbed. But most oppose a requirement that companies cover their workers, and they fear new taxes to help finance subsidies for low-income people and for establishing federal insurance coverage.

WHO'S INSURED, HOW

How many people have health insurance now, and how would that change if the system is overhauled?

THE POLITICS: One of the driving causes behind the longtime effort to overhaul the system is the desire to reduce the number of families that lack health insurance. The number of people without insurance rose to 46.3 million in 2008, or about 15 percent of the population, according to the Census Bureau. About 60 percent of Americans get coverage through an employer, or about 176 million people. Medicare, the government program for retirees, covers most of those 65 years or older - about 41 million beneficiaries. Medicaid provides health coverage for low-income children, families and people with disabilities - about 40 million people.

WHAT IT MEANS: The insurance industry supports the idea of universal health insurance coverage because it would add individuals to their risk pools, many of them young and healthy, and thus reduce their costs. They oppose the idea of insuring workers through a government-run plan that would compete with private plans. Legislation pending in Congress would require Americans to obtain insurance, but exemptions would stop short of making it universal. A bill just passed by the Senate Finance Committee would increase the number of insured nonelderly residents by about 29 million, or from 83 percent to about 94 percent, according to the Congressional Budget Office. A House bill would increase the number by 37 million, leaving 17 million uninsured, the CBO concluded.

DOCTORS' VIEW

Do doctors support reshaping the system?

THE POLITICS: The American Medical Association has specifically backed a House version of the effort, and it and other physicians' organizations have generally endorsed the overhaul effort. They would benefit if the legislation results in millions of additional, insured patients. Doctors recently won support from Senate Democratic leaders for one of their top priorities: blocking scheduled deep cuts in physicians' Medicare reimbursements. However, efforts to move ahead on legislation fell short in the Senate and now doctors have to wait for lawmakers to act. Democrats hope their backing for the effort will make physicians even more energetic supporters of the drive to revamp health care.

WHAT IT MEANS: Doctors still have plenty of concerns about what Congress might do. They worry their reimbursement rates under proposed government-run insurance plans would be tied to Medicare fees, which they consider too low. They oppose an independent Medicare commission that could cut doctors' reimbursements from the program, and want lawmakers to curb medical malpractice suits. They are also fragmented. Some state doctors' groups, like those in Georgia, oppose the AMA's stance, citing concerns about federal encroachment in determining what care is proper. Specialists are afraid cost-containment efforts will limit the patients they see. Neurological surgeons say Democrats' agreement to block scheduled Medicare reductions doesn't go far enough in protecting their incomes.

The Associated Press

The debate about the health care system's overhaul is filled with topics and terms unfamiliar to many. Each week, we'll examine some of the issues, the politics behind them and how they would affect consumers.

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